Prolonged thioguanine therapy is well tolerated and safe in the treatment of ulcerative colitis

Digestive and Liver Disease

Volumn 43, Issue 2, 2011, Pages 110-115

  Van Asseldonk, Dirk P ^a   Jharap, Bindia ^a   Kuik, Dirk J ^a   de Boer, Nanne K H ^a   Westerveld, Barend D ^b   Russel, Maurice G V M ^c   Kubben, Frank J G M ^d   van Bodegraven, Ad A ^a   Mulder, Chris J ^a  

^a VU UNIVERSITY MEDICAL CENTER   (Netherlands)

^b ISALA HOSPITAL   (Netherlands)

^c MEDISCH SPECTRUM TWENTE   (Netherlands)

^d Maasstad Hospital Rotterdam   (Netherlands)

Author keywords

Inflammatory bowel disease; Safety; Thiopurines; Tolerability

Indexed keywords

AMINOSALICYLIC ACID; AZATHIOPRINE; CORTICOSTEROID; CYCLOSPORIN; INFLIXIMAB; MERCAPTOPURINE; MESALAZINE; TACROLIMUS; TIOGUANINE;

ADULT; ARTHRALGIA; ARTICLE; CLINICAL ARTICLE; COLONOSCOPY; DATA BASE; DRUG EFFICACY; DRUG ERUPTION; DRUG RESISTANCE; DRUG SAFETY; DRUG SUBSTITUTION; DRUG TOLERABILITY; DRUG WITHDRAWAL; ECHOGRAPHY; FATIGUE; FEMALE; FEVER; FOLLOW UP; GASTROINTESTINAL DISEASE; GASTROINTESTINAL SYMPTOM; HEADACHE; HEPATOMEGALY; HUMAN; LIVER BIOPSY; LIVER HISTOLOGY; MALE; MULTICENTER STUDY; MYALGIA; PANCREATITIS; PRIORITY JOURNAL; PROCTITIS; REMISSION; SIDE EFFECT; THROMBOCYTOPENIA; TREATMENT DURATION; TREATMENT FAILURE; ULCERATIVE COLITIS;

ADULT; AGED; ANTI-INFLAMMATORY AGENTS, NON-STEROIDAL; COLITIS, ULCERATIVE; DATABASES, FACTUAL; DRUG THERAPY, COMBINATION; FEMALE; FOLLOW-UP STUDIES; GASTROINTESTINAL AGENTS; HUMANS; MALE; MIDDLE AGED; NETHERLANDS; ODDS RATIO; THIOGUANINE; TIME FACTORS; TREATMENT OUTCOME;

EID: 78651455298     PISSN: 15908658     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.dld.2010.07.004     Document Type: Article

References (29)

1. Jharap B., Seinen M.L., De Boer N.K., et al. Thiopurine therapy in inflammatory bowel disease patients: analyses of two 8-year intercept cohorts. Inflamm Bowel Dis 2010, 10.1002/ibd.21221.
2. Chande N., MacDonald J.K., McDonald J.W. Methotrexate for induction of remission in ulcerative colitis. Cochrane Database Syst Rev 2007, CD006618.
3. Rutgeerts P., Sandborn W.J., Feagan B.G., et al. Infliximab for induction and maintenance therapy for ulcerative colitis. N Engl J Med 2005, 353:2462-2476.
4. Dubinsky M.C., Hassard P.V., Seidman E.G., et al. An open-label pilot study using thioguanine as a therapeutic alternative in Crohn's disease patients resistant to 6-mercaptopurine therapy. Inflamm Bowel Dis 2001, 7:181-189.
5. Derijks L.J., De Jong D.J., Gilissen L.P., et al. 6-Thioguanine seems promising in azathioprine- or 6-mercaptopurine-intolerant inflammatory bowel disease patients: a short-term safety assessment. Eur J Gastroenterol Hepatol 2003, 15:63-67.
6. Dubinsky M.C., Vasiliauskas E.A., Singh H., et al. 6-Thioguanine can cause serious liver injury in inflammatory bowel disease patients. Gastroenterology 2003, 125:298-303.
7. Seiderer J., Zech C.J., Reinisch W., et al. A multicenter assessment of liver toxicity by MRI and biopsy in IBD patients on 6-thioguanine. J Hepatol 2005, 43:303-309.
8. De Boer N.K., Zondervan P.E., Gilissen L.P., et al. Absence of nodular regenerative hyperplasia after low-dose 6-thioguanine maintenance therapy in inflammatory bowel disease patients. Dig Liver Dis 2008, 40:108-113.
9. Ansari A., Elliott T., Fong F., et al. Further experience with the use of 6-thioguanine in patients with Crohn's disease. Inflamm Bowel Dis 2008, 14:1399-1405.
10. Dervieux T., Boulieu R. Simultaneous determination of 6-thioguanine and methyl 6-mercaptopurine nucleotides of azathioprine in red blood cells by HPLC. Clin Chem 1998, 44:551-555.
11. Lennard L., Singleton H.J. High-performance liquid chromatographic assay of the methyl and nucleotide metabolites of 6-mercaptopurine: quantitation of red blood cell 6-thioguanine nucleotide, 6-thioinosinic acid and 6-methylmercaptopurine metabolites in a single sample. J Chromatogr 1992, 583:83-90.
12. Shipkova M., Armstrong V.W., Wieland E., et al. Differences in nucleotide hydrolysis contribute to the differences between erythrocyte 6-thioguanine nucleotide concentrations determined by two widely used methods. Clin Chem 2003, 49:260-268.
13. De Boer N.K., Reinisch W., Teml A., et al. 6-Thioguanine treatment in inflammatory bowel disease: a critical appraisal by a European 6-TG working party. Digestion 2006, 73:25-31.
14. Teml A., Schwab M., Harrer M., et al. A prospective, open-label trial of 6-thioguanine in patients with ulcerative or indeterminate colitis. Scand J Gastroenterol 2005, 40:1205-1213.
15. Qasim A., McDonald S., Sebastian S., et al. Efficacy and safety of 6-thioguanine in the management of inflammatory bowel disease. Scand J Gastroenterol 2007, 42:194-199.
16. Almer S.H., Hjortswang H., Hindorf U. 6-Thioguanine therapy in Crohn's disease - observational data in Swedish patients. Dig Liver Dis 2009, 41:194-200.
17. Dubinsky M.C., Feldman E.J., Abreu M.T., et al. Thioguanine: a potential alternate thiopurine for IBD patients allergic to 6-mercaptopurine or azathioprine. Am J Gastroenterol 2003, 98:1058-1063.
18. Bonaz B., Boitard J., Marteau P., et al. Thioguanine in patients with Crohn's disease intolerant or resistant to azathioprine/mercaptopurine. Aliment Pharmacol Ther 2003, 18:401-408.
19. Szumlanski C.L., Weinshilboum R.M. Sulphasalazine inhibition of thiopurine methyltransferase: possible mechanism for interaction with 6-mercaptopurine and azathioprine. Br J Clin Pharmacol 1995, 39:456-459.
20. De Boer N.K., Wong D.R., Jharap B., et al. Dose-dependent influence of 5-aminosalicylates on thiopurine metabolism. Am J Gastroenterol 2007, 102:2747-2753.
21. Wanless I.R. Micronodular transformation (nodular regenerative hyperplasia) of the liver: a report of 64 cases among 2,500 autopsies and a new classification of benign hepatocellular nodules. Hepatology 1990, 11:787-797.
22. Minervini M.I., Ruppert K., Fontes P., et al. Liver biopsy findings from healthy potential living liver donors: reasons for disqualification, silent diseases and correlation with liver injury tests. J Hepatol 2009, 50:501-510.
23. De Boer N.K., Tuynman H., Bloemena E., et al. Histopathology of liver biopsies from a thiopurine-naive inflammatory bowel disease cohort: prevalence of nodular regenerative hyperplasia. Scand J Gastroenterol 2008, 43:604-608.
24. Gilissen L.P., Derijks L.J., Driessen A., et al. Toxicity of 6-thioguanine: no hepatotoxicity in a series of IBD patients treated with long-term, low dose 6-thioguanine. Some evidence for dose or metabolite level dependent effects?. Dig Liver Dis 2007, 39:156-159.
25. De Boer N.K., Mulder C.J., van Bodegraven A.A. Nodular regenerative hyperplasia and thiopurines: the case for level-dependent toxicity. Liver Transpl 2005, 11:1300-1301.
26. Seiderer J., Zech C.J., Diebold J., et al. Nodular regenerative hyperplasia: a reversible entity associated with azathioprine therapy. Eur J Gastroenterol Hepatol 2006, 18:553-555.
27. Ferlitsch A., Teml A., Reinisch W., et al. 6-Thioguanine associated nodular regenerative hyperplasia in patients with inflammatory bowel disease may induce portal hypertension. Am J Gastroenterol 2007, 102:2495-2503.
28. Zech C.J., Seiderer J., Reinisch W., et al. Thioguanine-induced nodular regenerative hyperplasia of the liver-ROC analysis of different MR techniques. Eur Radiol 2007, 17:1898-1905.
29. Herrlinger K.R., Kreisel W., Schwab M., et al. 6-Thioguanine - efficacy and safety in chronic active Crohn's disease. Aliment Pharmacol Ther 2003, 17:503-508.